Cognitively impaired residents often have difficulty with basic tasks such as following directions and recalling information. To help caregivers and patients live as comfortably and safely as possible, it is important to have a strong understanding of cognitive impairment and its effects on daily living. The following practice test is designed to help you better understand how an individual with cognitive impairment might respond to common tasks and situations.
This is a timed quiz. You will be given 90 seconds per question. Are you ready?
If a resident exhibits paranoid behavior, what should the nurse aide know?
Delusions occur when residents interpret a situation with a false understanding. For example, a resident may hear others talking in the dining room and decide there is a plot to poison his or her food. When dealing with delusions, remember the Three R's: reassure, respond, and refocus. Don't try to explain to the resident why he or she is wrong. Acknowledge the fear and address it from your perspective: "I don't know how anyone could poison your meals, but you seem upset." Offer a solution, such as "I can get your tray directly from the kitchen." Remember that the resident will have a difficult time distinguishing between reality and fantasy, so your reassurance will have a calming effect.
If a resident's behavior becomes combative, the nurse aide should
If you are hit by a resident while you're giving care, notify the nurse. You may be asked to complete an Incident Report. If you are injured, get treatment. Always remove yourself from harm by stepping out of the way of the resident's reach. Remain calm and explain to the person that hitting is not acceptable.
As dementia progresses, incontinence can become an issue. How can the nurse aide assist?
As dementia progresses, the resident may start to have episodes of incontinence. Don't start using adult diapers immediately, however. Establish a toileting schedule and take the resident to the bathroom at regular times. Don't wait for the resident to let you know when he or she needs to use the bathroom. Start watching for signs of need to go to the bathroom: Is the resident restless? Is he or she crossing legs? Pulling at clothing? If so, don't wait for the next scheduled time; take the resident to the bathroom immediately. When the resident is going out, prepare by taking a change of clothing with you and watching for restrooms. If an accident happens, stay positive to reduce the resident's embarrassment.
A confused resident tells you there is a monster in the closet. You should
If a client is confused, do not play along. Supporting the confusion or hallucination will only add to the client's fears. Sensible explanations will not be helpful either, because the client absolutely believes the fantasy. The best approach is to calmly address the situation directly. Accompany the client to the closet, reinforcing reality. Remain with the client, reminding the person of his or her surroundings.
When caring for a confused resident, what should a nursing assistant do?
When speaking to a client who is confused or agitated, use a calm voice. Talk directly to the client, saying the person's name. Use short sentences and allow time for the client to respond. Be respectful and always treat the client like an adult.
Communication with a resident who has late-stage dementia or Alzheimer's includes
Residents with late-stage dementia or Alzheimer's lose their ability to communicate with speech. They are still able to understand some verbal communication, so talking to them in simple sentences can be useful. They can also express themselves with facial expressions, emotions, and body language.
A resident has difficulty remembering what day it is and where the person is. How can you best help the resident?
Memory prompts are ways to help clients stay oriented to place and time. A calendar and a clock in each client's room are useful. Bulletin boards and public areas can be decorated for seasons and holidays. Repeat information at regular intervals to reinforce where the client is and what is happening.
Residents with cognitive impairments often have difficulty sleeping. What can be helpful?
Confusion and other symptoms can become exaggerated with fatigue. Causes of sleep problems for all residents include the natural aging process, medication side effects, pain, and nightly urination. For residents with dementia, there is also a disrupted circadian rhythm as well as fewer deep sleep cycles. Establishing a bedtime routine can reset a resident's internal clock and make it easier for the person to fall asleep. Increased physical activity during the day can improve the quality of sleep.
For a resident, reality orientation should include
Reality orientation involves repeating orienting information to help clients understand their surroundings. To keep a client oriented, his or her name should be used frequently. Information such as dates and times can be reinforced with calendars and clocks.
The Global Deterioration Scale (GDS) helps caregivers understand how people with dementia decline over time. Which of the following stages has no signs of dementia?
CNAs who work in a facility with residents who have dementia or Alzheimer's disease will become familiar with the GDS. Stages 1–3 are pre-dementia, with none or few signs of decline. Stage 4 includes signs of inability to concentrate, inability to finish tasks, and social withdrawal. Stage 5 includes some difficulty with activities of daily living (ADL) and inability to recall current information, such as today's date or the resident's current location. Stage 6 requires extensive help with ADL, incontinence, and inability to recognize family members. Stage 7 includes being unable to speak or walk. Residents with stage 7 dementia will need complete care.
When getting dressed, a client always wants to wear her favorite outfit. What is a good solution?
For a client with dementia, getting dressed can be a source of confusion. Simplify the process by limiting choices of clothing. If the client has a favorite outfit, try to get several identical sets. Clothing should be comfortable and easy to get on or off. Help the client by placing clothes in the order they are put on.
A way to make sure a resident with dementia gets adequate nutrition is to
For a resident with dementia, eating can be a challenge. Start by reducing distractions. Make the dining area quiet and calm so the resident can focus on the meal. Make it easy for the resident to eat by serving finger foods, using bowls instead of plates, and putting lids on cups. Small meals and snacks are appropriate for the limited attention span of these residents.
While the nurse aide is giving care to Mr. T., he calls the nurse aide by the name of his son who died several years ago. The nurse aide’s BEST response is to
Because of their memory loss, it is common for clients with dementia to mix up the names of others. They may even be aware that they are confused, but they can't figure out why. When they refer to someone who is no longer living, they may have been thinking about the person. Help them remember by asking about the person. If there is a photo or memento of the person, show it to them and help them reminisce about happier times.
A resident is standing in the hallway, holding a bag. She asks the nurse aide when the train is due. The aide should tell her
If a client is confused, do not play along. This only adds to the client's confusion and frustration. Gently tell the client where she is and guide her back to her room. Use her name, remind her of her surroundings, and stay with her until she feels calm and reassured.
A person with dementia is being admitted to your facility. Which of the following statements are correct?
People who have dementia or Alzheimer's disease have a different process for their transition into a long-term care facility. The process is fast, with much of it performed before the person arrives. To help the person adjust, the family does not stay but leaves so the staff can start helping the person to learn his or her new routine and meet others with similar conditions. Sometimes the family does not return until the staff believes the person is ready for a short visit.
All of the following are signs of aggressive behavior EXCEPT
Knowing the signs of aggressive behavior can help you prevent a situation from escalating. An aggressive episode can develop unexpectedly. If the client has a clenched jaw or fist, or suddenly begins to pace or rock, act quickly. Assess the situation to find a possible cause. Is the client in pain? Tired or hungry? Overstimulated? Confused? Use a calm manner to deal with the client. Eliminate distractions and try to focus on a new activity.
A resident with dementia has wandered into another unit. What should the nurse aide say to the resident after finding the person?
Six out of ten patients with dementia will wander. Even in the early stages of dementia, a resident can become confused for a short time. The person may become restless or try to do former activities, such as going to work or "going home."
A resident with Alzheimer’s disease tells the nurse aide that she smells smoke. The nurse aide should
Often the first symptom of Alzheimer's disease is a loss of short-term memory. The client can still recall events and information about the past until the disease progresses to complete loss of brain function. Depending on the stage of Alzheimer's, a client could certainly detect the smell of a fire.
Which of the following is NOT true of patients with dementia?
As dementia progresses, a client can exhibit any of the "Four A's" of agitation, anxiety, anger, or aggression. These behaviors are not intentional; they are signs of the disease. Remain calm and reassuring during these episodes. Redirecting the client is often a good way to end the behavior.
Toward the end of the day, residents with dementia commonly experience which of the following?
In the late afternoon or evening, caregivers may notice a major change in the behavior of clients with dementia. Fading daylight seems to trigger confusion and agitation, a condition known as Sundown Syndrome or Sundowners Syndrome. It is also connected to hunger, poor vision, and less natural light. Take the time to recognize the response of each resident who exhibits different behaviors. Does twilight seem to cause confusion? Are lamps or other lights on? Could the resident be hungry? Does poor vision make it difficult to see?
The primary cause of combative behavior in a resident with dementia is
The most common cause for combative behavior in clients with dementia is confusion about their care. Because of memory loss, clients become confused when staff members try to help them. Clients may not recognize their caregivers or may not want to do what the caregiver is telling them, such as to get up, eat, or take a shower. The clients' automatic reaction will be to say "No," and push, hit, or kick. Always allow plenty of time when dealing with such clients. Speak softly and explain what is happening. Don't argue. Remain calm and be prepared to try again in a few minutes.
A resident who has not been discharged insists she is going home. What should the nurse aide do?
It is beyond the scope of practice for a nurse aide to deal with some client situations, such as leaving against medical advice (AMA). Immediately inform the nurse or a supervisor. Stay with the client and reassure her that the nurse will help her. Try to redirect her focus or offer a new activity.
A client with dementia has developed a fear of taking a shower. What can a nurse aide do?
For a client with dementia, a shower or bath can be a frightening experience. Be patient and plan ahead. Gather everything needed and make sure the room is warm. In a gentle voice, tell the client what is going to happen throughout the process. Encourage the client to do as much as possible. Don't rush, and never leave the client alone. If the client refuses to shower, give the person a bed bath and try a shower another day.
Which of the following is an important way to help a resident feel comfortable in a long-term care facility?
During any change or transition, it is important to have familiar objects nearby. Special possessions, such as small pieces of furniture, blankets, photos, or mementos are important. Even personal items like soaps and shampoos can make a new environment more comfortable. If the resident has a family, encourage them to visit so that the resident does not feel abandoned.
If a resident becomes confused, you should
When a resident seems confused, start by offering basic information: "Hello, Mr. Roberts. I'm Sally, your nurse aide. Do you remember me?" From there, offer other ways to help the resident regain his or her sense of time and place: "It's Tuesday, August 26. You had chicken for lunch and watched the movie." Returning the resident to his or her room to look at familiar objects and photos can also be helpful. Always remain calm and friendly.
